Sleep disturbances, posttraumatic stress, and psychological distress among survivors of the 2013 Super Typhoon Haiyan

A systematic review of mental health and climate change in the Philippines

The Philippines are at the forefront of climate change impacts, including those related to health and well-being, but information on mental health and well-being are typically underreported. To help address this research lacuna, we conducted a systematic literature review. We aimed to provide an overview of current research knowledge and research gaps regarding the impacts of climate change outcomes on Filipinos' mental health and well-being. Consulting 8 databases, we identified 951 records. The final analysis included 32 studies: 16 quantitative, 11 qualitative, 2 longitudinal, 2 experimental, and 1 published report. A narrative synthesis has been performed to synthesize the findings from included studies. Studies were presented in four sections: 1) Risks to mental health following a natural disaster, 2) Determinants of post-traumatic stress disorder risks, 3) Resilience and post-traumatic growth following natural disasters, and 4) Personal experiences and other mental health outcomes. Reviewed data show that climate change outcomes strongly and negatively impact Filippino's mental health and well-being. Climate change outcomes also, negatively affect mental health through indirect (e.g., sleep disorders) and long-term pathways for example by being exposed to stressors such as migration, conflict, and violence. A set of coping strategies was identified which include banding together, mobilizing health experts, and expanding the local relationships with health workers. Future prospective studies should assess the effects of rising sea levels and vector-borne diseases among frontline communities. More interventional studies assessing preventive interventions and health promotion initiatives should be carried out to mitigate mental health disorders and improve well-being, thus contributing to improved health outcomes.

Impact of extreme weather events on mental health in South and Southeast Asia: A two decades of systematic review of observational studies

Extreme weather events in South and Southeast Asia exert profound psychosocial impacts, amplifying the prevalence of mental illness. Despite their substantial consequences, there is a dearth of research and representation in the current literature. We conducted a systematic review of observational studies published between January 1, 2000, and January 20, 2024, to examine the impact of extreme weather events on the mental health of the South and Southeast Asian population. Quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale (NOS) quality appraisal checklist. The search retrieved 70 studies that met the inclusion criteria and were included in our review. Most were from India (n = 22), and most used a cross-sectional study design (n = 55). Poor mental health outcomes were associated with six types of extreme weather events: floods, storm surges, typhoons, cyclones, extreme heat, and riverbank erosion. Most studies (n = 41) reported short-term outcome measurements. Findings included outcomes with predictable symptomatology, including post-traumatic stress disorder, depression, anxiety, general psychological distress, emotional distress and suicide. Limited studies on long-term effects showed higher mental disorders after floods and typhoons, while cyclone-exposed individuals had more short-term distress. Notably, the review identified over 50 risk factors influencing mental health outcomes, categorized into six classes: demographic, economic, health, disaster exposure, psychological, and community factors. However, the quantitative evidence linking extreme weather events to mental health was limited due to a lack of longitudinal data, lack of control groups, and the absence of objective exposure measurements. The review found some compelling evidence linking extreme weather events to adverse mental health in the South and Southeast Asia region. Future research should focus on longitudinal study design to identify the specific stressors and climatic factors influencing the relationship between climate extremes and mental health in this region.

Impact of climate-induced floods and typhoons on geriatric disabling health among older Chinese and Filipinos: a cross-country systematic review

BACKGROUND

Apart from both China and the Philippines continuing to be exposed to and affected by different climate-induced hazards, in particular floods and typhoons, they are also reported to be witnessing rapid ageing populations of 60 years and older. As such, this systematic review synthesized the existing evidence about the impacts aggravated by floods and typhoons on the geriatric disabling health of older Chinese and Filipinos, respectively.

METHODS

Four (4) electronic databases were systematically searched to identify eligible studies published between 2000 and early 2023. This process had to confirm the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), as well as the standard protocol registered with PROSPERO (CRD42023420549).

RESULTS

Out of 317 and 216 initial records retrieved for China and the Philippines, respectively, 27 (China) and 25 (Philippines) studies were eligible for final review. The disabling conditions they reported to affect the health of older adults were grouped into 4 categories: cognitive and intellectual, physical, chronic and terminal illnesses, and mental and psychological, with the latter identified as the most prevalent condition to affect older Chinese and Filipinos. On a sub-category level, posttraumatic stress disorder (PTSD) was the most common condition reported in 27 flood-related studies in China, while injuries and wounds prevailed in the Philippines, according to 25 typhoon-related studies.

CONCLUSION

The increasing occurrence of extreme climate hazards, especially floods and typhoons in China and the Philippines, respectively, impacted the health of their older adults with various disabling effects or conditions. Therefore, this calls for appropriate geriatric-informed interventions in the context of climate change and rapidly ageing settings beyond China and the Philippines to others that are also prone to floods and typhoons.

Variability in the psychological impact of four waves of COVID-19: a time-series study of 60 000 text-based counseling sessions

BACKGROUND

Continuous exposure to stressors can lead to vulnerability and, in some cases, resilience. This study examined the variation in its psychological impact across the first four waves of COVID-19 in Hong Kong.

METHODS

Transcripts from Open Up, an online text-based counseling service, between January 2019 and January 2021 were analyzed (N = 60 775). We identified COVID-19 mentioned sessions using keywords and further categorized them into those that also mentioned symptoms of common mental disorders (CMDs) and those that did not. Autoregressive integrated moving average models were used to analyze the associations between the severity of the outbreak and the mention of COVID-19 and CMDs.

RESULTS

Results revealed that the pandemic led to increased psychological distress. Compared to prior to its advent, more people sought help in the initial months of the outbreak. Furthermore, associations were found between the severity of the outbreak and the number of help-seeker mentioning the pandemic, as well as between the outbreak severity and the number of help-seekers disclosing psychological distress. However, these relationships were not uniform across the four waves of outbreaks; a dissociation between outbreak severity and help-seekers' concern was found in the fourth wave.

CONCLUSION

As the pandemic waxes and wanes, people may become habituated to its psychological toll. This may be interpreted as a form of resilience. Instead of worsening with time, the psychological impact of COVID-19 may reduce with repeated exposure.

Relationship between covid-pandemic anxiety and sleep disorder with menstrual disorders among female medical workers

BACKGROUND

It has been more than 2 years since the 2019 novel coronavirus disease (COVID-19) pandemic destabilized the world, adversely affecting not only physical health, but also mental health. During this time, frontline medical workers were at a greater health risk, especially female medical workers. Changes or abnormalities in the menstrual cycle-an important indicator of women's health-may jeopardize female reproductive functioning. Considering that emotional health and sleep status may be related to the menstrual cycle, this study aimed to investigate the association between menstrual cycle changes, anxiety, sleep dysfunction, and other factors among female medical workers during the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted by distributing online questionnaires to female medical workers in China from February to May 2022. The study included 160 women aged 18-45 years old. The questionnaires covered data related to the participants' sociodemographic characteristics, medical and reproductive history, and lifestyle. The Rating Scale for Clinical Manifestations of Menopathy (SCMM), Self-Rating Anxiety Scale (SAS), and Sleep Dysfunction Rating Scale (SDRS) were utilized. Data were analyzed using chi-square tests, t-tests, and linear regression analysis.

RESULTS

A total of 160 female medical staff were randomly selected in this research, of whom seven scored less than 3 points, 85 scored 3-11 points, and 68 scored more than 11 points on the total score of the SCMM. Compared to pre-pandemic scores, scores of dizziness and tinnitus were significantly higher during the COVID-19 pandemic. Scores corresponding to the following clinical symptoms were also higher during the pandemic: Menopathy, including hypaphrodisia, dim complexion, abnormal urination, languidness, dim menstruation, thin menstruation, dysmenorrhea, and empty or saggy lower abdomen (p < 0.05). However, pre-pandemic scores of vaginal bleeding quantity were significantly higher than those found during the COVID-19 pandemic (p < 0.05). Scores of vaginal bleeding quantity were significantly lower in cabin hospitals than other types of hospitals, and a similar finding was observed for vaginal bleeding duration (all p < 0.05). Moreover, the findings of the univariable and multivariable linear regression analysis revealed a link between consistent exercise, the underlying illness, the SDRS score, the SAS score, and the total score of SCMM (p < 0.05).

CONCLUSIONS

In this study, we found that menstruation in female medical workers was affected by the COVID-19 pandemic. Furthermore, regular exercise and good physical condition were protective factors, while anxiety and insomnia were risk factors for menstrual abnormalities.

The Indirect Effect of Sleep on the Association Between Protracted Social Stressors and Psychological Distress Among Hong Kong Young People

PURPOSE

Hong Kong youth and young adults experienced unprecedented stress amid social unrest and the COVID-19 pandemic. Few studies have examined how these stressors were related to psychological distress among youth and young adults. This study assessed how psychological distress is associated with stress from social unrest, financial circumstances, and the COVID-19 pandemic, and whether poor sleep quality may explain these associations.

METHODS

Participants of a representative phone survey included 1,501 Hong Kong youth and young adults (Mage = 26.1 (4.0); 48.2% female). We examined the associations between psychological distress and three types of stress (social unrest, financial, and COVID-19 stress), and the indirect effect of poor sleep.

RESULTS

Eleven point nine percent, 4.1%, and 9.7% of respondents reported feeling very seriously distressed by social unrest, financial circumstances, and the COVID-19 pandemic, respectively. All three forms of stress were associated with poor sleep. The indirect effects of poor sleep on the association between all three forms of stress and psychological distress were identified. Moderated indirect effect analysis indicated that being female intensified the effect of COVID-19-related stress on psychological distress and that younger female youth and older male youth were more vulnerable to financial stress and social unrest stress (vs. older female youth and younger male youth).

DISCUSSION

Sleep may be one mechanism that accounts for the association between psychological distress and protracted stressors among Hong Kong youth and young adults. These results suggest the importance of prioritizing sleep improvement in mental health interventions during times of societal change.

Mental Health Disturbance after a Major Earthquake in Northern Peru: A Preliminary, Cross-Sectional Study

Little has been studied in Peru on the mental health repercussions after a major earthquake. We aimed to explore the factors associated with depressive and anxiety symptoms in people who experienced a 6.1 magnitude earthquake in Piura, Peru, on 30 July 2021. A preliminary cross-sectional study was conducted in the general population between August–September 2021. An online questionnaire was provided using PHQ-9, GAD-7, and other relevant measures. Generalized linear models were applied. Of the 177 participants, the median age was 22 years, the majority were female (56%), and many experienced depressive (52%) or anxiety symptoms (52%). Presence of depressive symptoms was associated with a personal history of mental disorder, moderate housing damage, social/material support from politicians, moderate food insecurity, and insomnia. Presence of anxiety symptoms was associated with physical injury caused by the earthquake, mild food insecurity, and insomnia. The development of depressive and anxiety symptoms following the 2021 earthquake experienced in Piura depended on multiple individual and socioeconomic factors. Additional studies should reinforce the factors identified here given the methodological limitations, such as the study design, sampling method, and sample size. This would lead to effective intervention measures to mitigate the impact of earthquakes on mental health.

Network analysis of comorbid posttraumatic stress disorder and depression in adolescents across COVID-19 epidemic and Typhoon Lekima

BACKGROUND

Network analytic studies indicate that posttraumatic stress disorder (PTSD) may be comorbid with depression at the symptom level, but it remains unclear whether these findings are replicable and generalizable across trauma types.

OBJECTIVE

This study aim was to examine and compare PTSD-depression comorbidity networks of two types of trauma related to Typhoon Lekima and COVID-19 epidemic.

METHODS

Participants were 1605 and 601 adolescents recruited following Typhoon Lekima and the COVID-19 outbreak, respectively.

RESULTS

COVID-19 and Lekima PTSD-depression networks had considerable similarities, including adequate stability and accuracy, connected symptoms of PTSD and depression, symptoms with high centralities, and bridge symptoms. PTSD-depression comorbid symptoms were more complicated in the COVID-19 network but may show more persistence in the Lekima network. Distinct bridge symptoms contributed to the heterogeneity of PTSD-depression comorbidity characteristics between the two networks. Specifically, restricted affect and felt down and unhappy were two important bridge symptoms with high centrality unique to the COVID-19 network.

CONCLUSIONS

PTSD-depression comorbidity network has considerable replicability across trauma types, but specific symptom-level associations and some bridge symptoms may vary across trauma types. These findings also highlight the importance of negative emotions to comorbid PTSD and depression in adolescents following the COVID-19 outbreak compared with Typhoon Lekima.

Climate change, climate-related disasters and mental disorder in low- and middle-income countries: a scoping review

INTRODUCTION

Climate change and climate-related disasters adversely affect mental health. Low- and middle-income countries (LMICs) are particularly vulnerable to the impacts of climate change and climate-related disasters and often lack adequate mental healthcare infrastructure. We used the scoping review methodology to determine how exposure to climate change and climate-related disasters influences the presence of mental disorders among those living in LMICs. We also aimed to recognise existing gaps in this area of literature.

METHODS

This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. To identify relevant studies, we searched five electronic databases (MEDLINE, EMBASE, Global Health, APA PsycInfo and Sociological Abstracts) from 1 January 2007 to 31 December 2019. We also searched the grey literature. Included studies had an adult-focused LMIC population, a climate change or climate-related disaster exposure and a mental disorder outcome. Relevant study information was extracted and synthesised.

RESULTS

Fifty-eight studies were identified, most of which (n=48) employed a cross-sectional design. The most commonly studied exposure-outcome combinations were flood-related post-traumatic stress disorder (PTSD) (n=28), flood-related depression (n=15) and storm-related PTSD (n=13). The majority of studies identified a positive exposure-outcome association. However, few studies included a baseline or comparator (ie, unexposed) group, thereby limiting our understanding of the magnitude or nature of this association. There was also great heterogeneity in this literature, making studies difficult to pool or compare. Several research gaps were identified including the lack of longitudinal studies and non-uniformity of geographic coverage.

CONCLUSION

To our knowledge, this was the first scoping review to investigate the relationship between climate change and climate-related disaster exposures and mental disorder outcomes in LMICs. Our findings support the need for further research, but also highlight that mental health should be a priority within LMIC climate change policy considerations.

Change patterns of sleep problems predict mental health problems among adolescents: a 10-year cohort study of Chinese Wenchuan earthquake

BACKGROUND

The predictive effects of change patterns of sleep problems on mental health after a long-term disaster remain poorly known. We examined the change patterns of sleep problems after the Wenchuan earthquake, and tested whether specific sleep-related change patterns could predict mental health problems (posttraumatic stress disorder [PTSD], anxiety, and depression) in the 10 years after Wenchuan earthquake.

METHODS

1357 adolescents exposed to the Wenchuan earthquake were surveyed on potential sleep problems at 18 months (T_18m) and 30 months (T_30m) post-earthquake. Among them, 799 participants completed the followed-up survey online 10 years after the earthquake (T_10y). Since some participants did not provide sleep problems data at both T_18m and T_30m, 707 samples were included in final analyses. Linear regression analysis was performed.

RESULTS

Four different patterns of sleep problems were identified: stable-low pattern (61.1%), stable-high pattern (15.3%), decreasing pattern (13.2%), and increasing pattern (10.5%). Additionally, we found that individuals in stable-high and increasing patterns were more likely to experience PTSD, anxiety, and depression at T_10y in the crude model. After controlling for confounders (e.g., earthquake exposure), these patterns were strongly predictive of depression at T_10y.

LIMITATIONS

Only two waves of sleep problems were collected and subjective sleep outcomes methods were used to collect data instead of objective methods.

CONCLUSIONS

Sleep problems had heterogeneity after a deadly earthquake. Individuals in stable-high and increasing patterns should be given more attention. Timely assessment and targeted interventions on specific sleep problems are necessary for preventing an escalation of adverse mental health outcomes.

Quality of life among people who use drugs living in poor urban communities in the Philippines

BACKGROUND

The quality of life (QOL) and mental health of people who use drugs (PWUD) in the Philippines, especially those living in poor urban communities, are highly concerning due to the situations surrounding drug use and the ongoing hard-line antidrug policy. This study aimed to investigate the QOL and mental health status of PWUD, compare them with a comparison group with no history of drug use, and identify factors associated with QOL among Filipino PWUD.

METHODS

A cross-sectional study was conducted with recruitment from a community-based rehabilitation programme and poor urban communities in Muntinlupa in 2018. QOL was measured using the WHOQOL-BREF, while psychological distress and posttraumatic stress disorder (PTSD) were measured using the Kessler Psychological Distress Scale (K-6) and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), respectively. Multivariable linear regressions with each WHOQOL-BREF domain as a dependent factor were conducted to establish three predictions: age- and gender-adjusted QOL means, factors associated with QOL among PWUD, and interaction of lifetime drug use with each covariate.

RESULTS

In total, 272 PWUD and 402 comparison participants were recruited. Most PWUD were current drug users (53%), primarily of methamphetamine (70%). Among PWUD, the prevalence of moderate to severe psychological distress was 70%, and probable PTSD was 28%-both rates higher than those among the comparison group. All four QOL domain scores (physical, psychological, social, and environmental) of PWUD were lower than those of the comparison group. Multivariable regressions showed that psychological distress, current drug use, selling drugs, experiencing discrimination, and being never-married were associated with lower QOL. Higher individual income, household resources, social activity participation, and service use for drug use problems were associated with higher QOL among PWUD. Stratified and interaction analyses revealed that the QOL of PWUD was more sensitive to changes in individual income relative to the QOL of comparison group.

CONCLUSION

A comprehensive intervention addressing psychological distress reduction, economic empowerment, and social inclusion-complementary to abstinence-oriented programmes-may improve the well-being of Filipino PWUD.

Measuring mental health burden in humanitarian settings: a critical review of assessment tools

BACKGROUND

The effects of disasters and conflicts are widespread and heavily studied. While attention to disasters' impacts on mental health is growing, mental health effects are not well understood due to inconsistencies in measurement.

OBJECTIVE

The purpose of this study is to review mental health assessment tools and their use in populations affected by disasters and conflicts.

METHOD

Tools that assess posttraumatic stress disorder, depression, substance use disorder, and general mental health were examined. This review began with a search for assessment tools in PubMed, PsycINFO, and Google Scholar. Next, validation studies for the tools were obtained through snowball sampling. A final search was conducted for scientific studies using the selected tools in humanitarian settings to collect the data for analysis. The benefits and limitations described for each tool were compiled into a complete table.

RESULTS

Twelve assessment tools were included, with 88 studies using them. The primary findings indicate that half of the studies used the Impact of Events Scale-Revised. The most common limitation discussed is that self-report tools inaccurately estimate the prevalence of mental health problems. This inaccuracy is further exacerbated by a lack of cultural appropriateness of the tools, as many are developed for Western contexts.

CONCLUSION

It is recommended that researchers and humanitarian workers reflect on the effectiveness of the mental health assessment tool they use to accurately represent the populations under study in emergency settings. In addition, mental health assessment should be coupled with action.

Psychiatric comorbidity predicts sleep disturbances among adolescent earthquake survivors: a 10-year cohort study

OBJECTIVE

To examine the prevalence of sleep disturbances 10 years after Wenchuan earthquake, and to explore whether comorbid post-traumatic stress disorder (PTSD) and depressive symptoms could predict sleep disturbances and whether such effects were modified by gender.

METHODS

Participants were 1357 adolescents in the Wenchuan Earthquake Adolescent Health Cohort Study (WEAHC). 799 of the participants completed the followed-up survey 10 years after the earthquake. At 12-month post-earthquake (T_12m), a battery of standardized measures were used to assess individual earthquake exposure, sleep disturbances (insomnia symptoms and poor sleep quality), PTSD, and depressive symptoms. At 10 years post-earthquake (T_10y), those survivors reported their sleep disturbances via an online survey. Data were analyzed using binary logistic regression.

RESULTS

The prevalence of insomnia (14.3%) and of poor sleep quality (19.8%) at T_10y decreased when compared with it at T_12m. After controlling for covariates, it is revealed that depression-only and comorbidity groups at T_12m predicted sleep disturbances at T_10y among the whole sample and males. As for females, who have depression-only and comorbidity were more likely to develop insomnia symptoms but not poor sleep quality.

CONCLUSIONS

Sleep disturbances remained highly prevalent among survivors even 10 years after the earthquake. Depression-only and comorbidity groups were related to higher risks of sleep disturbances, especially for males. Assessments and interventions targeting both depressive symptoms and comorbid PTSD to reduce sleep disturbances after a deadly disaster are warranted.

Impact of the Great East Japan Earthquake on the Employment Status and Mental Health Conditions of Affected Coastal Communities

The Great East Japan Earthquake devasted the old community in coastal areas characterized by primary industry. The number of unemployed people increased from 150,000 to 190,000 after the earthquake. All of the adult residents of Shichigahama (18 years old or older), located in the coastal area of the Miyagi prefecture, whose houses were totally or majorly damaged, were recruited for a survey conducted in October 2011. All of the residents who responded with written informed consent were included in this study. Among 904 individuals who had a job before the Great East Japan Earthquake, 19% became unemployed. Concerning gender and age, 9% of young men, 34% of elderly men, 21% of young women, and 49% of elderly women became unemployed. Concerning the type of industry, 38%, 15%, and 16% of people who had belonged to the primary, secondary, and tertiary industries, respectively, before the disaster became unemployed. Those who became unemployed exhibited a significantly higher risk of insomnia compared to those who maintained jobs. The study pointed out the severe impact of the Great East Japan Earthquake on populations who had belonged to the primary industry, especially among elderly women, and its effect on sleep conditions.

Social trust predicts sleep disorder at 6 years after the Great East Japan earthquake: data from a prospective cohort study

Background

The physical and psychological health impacts on victims of the Great East Japan Earthquake (GEJE) have lasted for a long time. Some cross-sectional studies have reported a relationship between social networks and/or social support and mental health among victims. Previous studies were cross-sectional observations at one time point after a disaster, it remains unclear whether the lack of social trust soon after the GEJE predicts long-term mental health outcomes among the victims. The objective of the present study was to examine prospectively the association between social trust soon after the GEJE and trends in sleep disorders up to 6 years after the GEJE.

Methods

We conducted a health survey on residents living in two areas affected by the GEJE. We analyzed data from 1293 adults (aged ≥18 years) who had participated in an initial health survey. The participants responded to a self-administrated questionnaire composed of items on health condition, mental health, including sleep disorders (based on the Athens Insomnia Scale [AIS]), and social trust. We classified the participants into two categories (high or low) based on the level of social trust at the first health survey. A linear mixed model was used to estimate trends in AIS scores in relation to social trust at the first health survey.

Results

The AIS scores of participants in the low social trust group were significantly higher than those in the high social trust group throughout the 6 years after the GEJE (P < 0.01). After adjusting for some covariates, the AIS score estimate for the participants who had low social trust was 1.30 point higher than those for the participants who had high social trust.

Conclusion

Social trust at 3 to 5 months after the GEJE predicted AIS scores at 6 years after the GEJE among victims. This finding suggests that it may be possible to identify people who have a lower potential for mental resilience from disaster damage over the long term. Further, health interventions for this high-risk group could help promote resilience after a disaster.

Posttraumatic Stress and Depression in the Aftermath of Environmental Disasters: A Review of Quantitative Studies Published in 2018

PURPOSE OF REVIEW

As interest in the mental health consequences of environmental disasters increases, this review aimed to summarize peer-reviewed studies published in 2018 on posttraumatic stress disorder (PTSD) and depression symptoms after such events.

RECENT FINDINGS

Notable trends in the past year of research included studies focusing on vulnerable populations (e.g., persons with preexisting physical health conditions), assessing the cumulative impact of exposure to multiple disasters, exploring pathway leading to PTSD and depression symptoms, and evaluating the effectiveness of post-disaster interventions. Over 100 articles were identified, focused on 40 disasters that occurred between 1982 and 2017. Prevalence estimates ranged from 0 to 70.51% for PTSD and 1.9 to 59.5% for depression. Consistent predictors of adverse outcomes included female gender, socioeconomic disadvantage, high disaster exposure, and low psychosocial resources. Further research that expands upon recent advances in the literature is critical given the large proportion of the world's population exposed to disasters and the increasing incidence of such events.

The impact of exposure to memorial reports on the 5.12 Wenchuan earthquake on sleep quality among adult survivors ten years after the disaster: Evidence for nonlinear associations

INTRODUCTION

Very few studies have explored the effect of exposure to disaster memorial reports in the media on long-term sleep quality during the recovery period and post-disaster era. This study investigated the relationship between exposure to memorial reports and adult survivors' long-term sleep quality 10 years after the 5.12 Wenchuan earthquake in 2008, and determined whether exposure to memorial reports are associated with poor sleep quality.

METHOD

Using a cross-sectional methodology, we surveyed participants (N = 1000) recruited from six disaster-affected counties. We measured sleep quality using the Pittsburgh Sleep Quality Index questionnaire (PSQI).

RESULTS

After controlling for the effects of demographic factors, socioeconomic status, and earthquake exposure factors, exposure to memorial reports and the PSQI global score had a strong inverted U-shaped relationship. Relationships among three sub-scores of PSQI (subjective sleep quality, sleep latency, daytime dysfunction) were also found to have similar relationships with memorial report exposure. That is, survivors who were exposed to low or high degrees of memorial reports had better sleep quality than those who were exposed to intermediate memorial reports.

DISCUSSION

The curvilinear relationship between media exposure and sleep quality in the post-disaster era reveals that media exposure could be used to identify victims at risk of poor sleep quality. Clinicians and practitioners may consider adopting psychological intervention programs to enhance victims' psychological controllability to overcome mental disorders caused by media exposure.

Longitudinal associations of radiation risk perceptions and mental health among non-evacuee residents of Fukushima prefecture seven years after the nuclear power plant disaster

We aimed to explore the effects of prolonged radiation risk perceptions on mental health after the Fukushima nuclear power plant accident occurred in 2011. We investigated the longitudinal associations of radiation risk perceptions five years after the accident with psychological distress and posttraumatic stress symptoms two years later among non-evacuee community residents of Fukushima prefecture. A two-wave questionnaire survey was administered for 4,900 randomly sampled residents in 49 municipalities of Fukushima prefecture excluding the evacuation area designated by the Japanese government. Radiation risk perceptions were assessed with a seven-item scale. Psychological distress and posttraumatic stress symptoms were measured by the K6 and the six-item abbreviated version of the Posttraumatic Stress Disorder Checklist-Specific version, respectively. We investigated the associations of radiation risk perceptions in the first survey conducted in 2016 with psychological distress and posttraumatic stress symptoms in the follow-up survey conducted in 2017–18, controlling for the baseline level of distress or symptoms using multivariate logistic regression analyses. Valid responses were obtained from 1,148 residents (23.4%). Higher risk perceptions of radiation exposure in the first survey predicted later posttraumatic stress symptoms but not psychological distress after controlling for baseline symptoms or distress. High risk perceptions of radiation exposure after nuclear power plant accidents can lead to posttraumatic stress symptoms.

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Radiation anxiety predicted later posttraumatic stress symptoms.

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Radiation anxiety did not predict later psychological distress.

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Radiation anxiety affected later mental health status among non-evacuee residents.

The relationship of severity of symptoms of depression, anxiety, and stress with sleep quality in earthquake survivors in Kermanshah

BACKGROUND

Earthquake is one of the most common natural disasters. A 7.3" Richter earthquake happened at 5km from the town of Ezgeleh in Kermanshah province in 2017, which caused several physical and mental injuries. The present study was conducted to investigate the sleep quality and mental health difficulties of those affected by earthquake and predict sleep quality according to severity of symptoms of depression, anxiety, and stress in the township of Sarpol-e Zahab, which suffered the most damage.

METHODS

A total of 999 earthquake survivors living in temporary tents and camps were assessed in terms of sleep quality and pattern using Pittsburgh Sleep Quality Index, and severity of psychological symptoms using Depression, Anxiety, and Stress scale 10 days after the disaster.

RESULTS

According to the results, poor sleep quality was experienced by 20.61% of survivors, severe stress by 60.5%, and severe depression by 41.5%, and moderate anxiety by 74%. The subjective quality, efficiency, daily dysfunction, use of hypnotics, and total sleep quality had a positive and significant relation with severity of experienced depression, anxiety, and stress. Sleep latency had a positive and significant relation only with stress, and sleep disturbance with depression and stress.

CONCLUSIONS

Severity of depression, anxiety, and stress can predict changes in total sleep quality of those affected by earthquake. Stress can be considered as the sole predictor of total sleep quality and the only factor that can explain components of sleep quality. The implications of the present study are debatable.